DR. Salzhauer: I want to remind all of our listeners that next week is the Miami Air and Sea show, and we will not be on the air at our usual time, because WFTL will be broadcasting live from the air and sea show, so we will be on two weeks from now. If you tune in next week. Don't be disappointed We will be on the following week. Okay, Jeannine?

Jeannine: Yes sir. WE do have a live caller. His name is James and he had a waddle removed. And it's back. James?

DR. Salzhauer: HI, James.

Jeannine: Hi, James. Welcome to Nip Talk.

James: Glad to be here.

DR. Salzhauer: Hi. This is the doctor. How can I help you, James?

James: Yes, sir. Well, 9 weeks ago I had this neck lift, and I also had a waddle removed, and a lower face. And the doctor said the waddle would never return. Well, here at 9 weeks, it's half way back now.

DR. Salzhauer: Huh. Well, can I ask you a question about the surgery. Were there incisions underneath the chin?

James: No. There was just a canula hole there.

DR. Salzhauer: Just a canula hole there. Was there an incision around the ears, or along the ears and hair line?

James: Yes, there was.

DR. Salzhauer: There was. Well, you know, it’s hard to second guess because I don't know what you looked like before the surgery. But usually, if the waddle is severe in a man, most of the time I have to make a long incision under the chin to get in and â I use that incision to A) get rid of some skin, and B) to tighten the muscles that can cause those bands, or the waddle, that's underneath there. It's very difficult to get a tightening in the middle from the incisions along the sides. And again, it really depends what caused your waddle and what you looked like beforehand. But typically, the typical chin waddle is caused by loose skin coupled with loose muscles. The muscle that causes that waddle is called the platisma muscle. It goes from your sternum, or your clavicle, right up to the corners of your lower lip. And over time, that muscle weakens, loosens, separates, and you get these bands along your neck that most people refer to as a waddle. So the skin can be removed by pulling along the incisions that you have, along the ears and behind the ears, and the muscles can be tightened usually by an incision just under the chin. And that incision is usually about 4 centimeters long, or about an inch and a half, close to 2 inches long. So you may just need to have your muscles tightened a little bit.

The second thing that it can be is, occasionally, after liposuction under the chin — which I think that's what he did with that little canula incision — you can get what's called a seroma, or a collection of fluid under the skin, and that fluid can actually stretch out the skin that's just been tightened with the surgery. And the stretching of that skin can cause you to have a little of the waddle to come back. So if there's fluid under there, sometimes you can remove it with a needle, and if you can feel fluid under there, it usually feels what we call “ballottable”. It feels like there's a little balloon filled with water under there. If you don't have that, than obviously that's not the cause. But I would go back to your doctor and I would ask him to explain all these things to you, and ask him what he did or did not do.

Again, sometimes there's just swelling post operatively that stretches the skin a little bit, and sometimes that can just go away with time as the scars and tissues heal underneath the neck. So I would hang in there. You said it was 8 weeks ago?

James: 9.

DR. Salzhauer: 9. Yeah, I mean it's possible that this will resolve. And again, we had a question earlier in the hour, which was how long to wait after a face lift for a revision. And the standard answer is one year, just to make sure everything heals properly, and that you've given everything a chance to settle into its proper place. There are some exceptions to that, and you may be an exception to that. So I would go back to my doctor and ask him –

James: There's also, well my neck was pulled the doctor put some drainage tubes in the back of my head.

DR. Salzhauer: That's normal.

James: And it's left some what looks like canals running down the back of my neck. And he said that they would disappear over time, but they look like they're getting worse.

DR. Salzhauer: Having those canals or those ridges is not uncommon. It doesn't happen all the time, but it certainly happens at least I would say at least 5 percent of the time. The vast majority of the time, those ridges do go away. And it is just a question of letting things settle. You're sort of in that in between stage, you're not quite yet at 3 months, and you don't yet see the results that you want. But remember, like I said earlier in the show: scar tissue builds up on the insides of your operation, and the outside of your skin continuously for the first 3 months. Then after 3 months, your body turns off that healing process, and everything starts to flatten, soften and remodel. So even though you see those little ridges now, your doctor's right, it may settle out after time. But the time frame we're looking at could be up to 6 months. So hang in there at least to that point regarding these ridges.

James: There's one more thing.

DR. Salzhauer: Sure, Go ahead.

James: The lower face lift, the right side of my face turned out beautifully, but the left side a hunk of skin is hanging way down there on my lip now. Like the doctor didn't even pull the underlying fascia. He just stretched the skin.

DR. Salzhauer: And it's the lip you said?

James: Yeah. It's hanging down by my mouth.

DR. Salzhauer: Right.

James: See, before, I had two big things hanging down off my chin, and by off my chin I mean chin line there. And he took those off beautifully. It looks like over the period of about 6 months to a year, it looks like it's gonna be back because all the things are hanging down there again.

Dr. Salzhauer: It's possible. You know, it's possible that your skin has not that much elasticity and again with post operative swelling you can see a hint of those jowls coming back. Whether it's permanent or not you'll just have to wait and see. I will say this: I have seen cases that sound similar to yours resolve on their own with time. So I would give it to at least 6 months before you make adjustments. And again, it's not that difficult to make a little tuck. The secrets, one of the secrets of face lifting, is nip and tuck-tuck-tuck. You have your first major face lift, and then you just tuck it every couple of years to keep it really tight. And that is the secret of a lot of these older movie stars and actors that look so good into their 70s and 80s. Because they do their face lifts and they tuck them or revise them on a regular basis to make sure they look as tight and as fresh as they did the day after surgery.

James; I'll ask him about that. That's practically the same thing he said, too. Don't panic right now. He said just wait for about 6 months, and see what happens.

DR. Salzhauer: Yeah. It'd wait about 6 months. Talk to your doctor about it. I'm sure he'll say similar things that I did, but it's important to be informed and to know what's going on in your own body and the time frame before you jump back into trying to revise things. Okay?

Jeannine: James, thank you so much for calling, and good luck with everything, okay? Thank you.

This entry was posted on Sunday, April 29th, 2007 at 11:00 am and is filed under Face Lift, Healing time, Men, Muscles, Neck Lift, Revisions, Scarring. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.